Contact with services

Contact with Health and Social Services, Hospital Admission, Contact with Medical Specialists


LASA044
LASA045 / LASA245
LASA603 / LASA703

Contact: Marjolein Broese van Groenou

Background
The health care system in the Netherlands covers a broad range of services, which can be differentiated in health services for acute care (e.g. GP and hospital), community social services (e.g. meals on wheels) and services for long term care (e.g. residential care). Many older adults will use one or more of the acute care services in later life. Access to these health care services is guaranteed by health care insurance, which is obligatory in the Netherlands. Community social services are designed for people who need help with instrumental activities  (e.g. chores around the house), social needs (e.g. social work) or with mental needs (e.g. due to substance abuse). These services can be provided in the home of the older adult or in a location in the community. The access to community social services is defined by local government since the Social Support Act (Wmo) was installed in 2007. Access to community mental health is organized under the Mental Health Act (GGZ). Finally, long term care services are available for the very old and the most impaired. Temporary or permanent residential care are arranged under the National Act of Exceptional Medical Expenses (AWBZ). Since 2015 the AWBZ has been split into the Chronic Care Act (Wlz) for residential care, and the Care Insurance Act (Zvw) for home care. The Social Support Act has extended the coverage since 2015 and now includes household help, transportation, mobility devices and guidance. Since 1992 the laws and systems for acute and long term care have changed considerably, which is reflected in the use of these services over time. According to the Behavioral Model of service use (Andersen & Newman 2005), both societal and individual factors determine the use of health and social services. Societal factors are reflected in the allocation and accessibility of services and care. Individual factors entail the need, disposition and factors enabling the use of care. This model has been used in a large number of papers and reports to explain variability in the use of care among older adults and over time. See the section on previous use in LASA and the references.

Measurement instruments in LASA

Respondents living in the community are provided with a list of health and social services (e.g. GP, dentist, volunteers, chores services) and indicate whether they had contact with one of these persons or services in the past six months. The nineteen options are categorized in the variables lst1c1 to lst1c19:

 

1) Family physician
2) Dentist
3) Physiotherapist
4) Dietician
5) Home nurse service/district nurse
6) Home help
7) Alpha help
8) Social work
9) Coordinated senior service
10) Telephonic help service
11) Telephone circle
12) Meals on wheels
13) Open table (food)
14) Volunteers UVV
15) Volunteers Zonnebloem
16) Transportation service
17) Chores services
18) Red Cross
19) Memory training

In LASA-B it was also investigated if the respondent knew each of the health and social services. In LASA-G, LASA-H, LASA-3B, LASA-MB and LASA-I a question was added about how often the respondent had had contact with the Family physician for him/herself over the last 6 Months.

In LASA-I two new services were added (lst1c20 and lst1c21):

20) social alarm or neckalarm

21) daycare in a group facility.


In LASA-G, LASA-H, LASA-3B, LASA-MB and LASA-I the answer categories regarding volunteers (14 and 15) were replaced by ‘a volunteer organisation, namely …….’. In LASA-3B and LASA-MB only eleven options were asked. These options were:

1) Family physician
2) Dentist
3) Physiotherapist
4) Dietician
5) Meals on wheels
6) Transportation services
7) Chores services
8) A volunteer organization, namely
9) Consultation office for alcohol & drugs
10) Socio-psychogeriatric service (SPGD)
11) Alternative practitioner

If the respondent lived in a residential care home or in a nursing home, the respondent was given another list with different services for mental health and residential care. The fifteen options are categorized in the variables lst2c1 to lst2c15. These options were:

1) Consultation office for alcohol & drugs    
2) Comm. for mental health care        
3) Socio-psychogeriatric service (SPGD)  
4) Rehabilitation center           
5) Indication commission elderly homes        
6) Alternative practitioner       
7) Nursing home-admission    
8) Nursing home-observation  
9) Nursing home-overnight stay                       
10) Nursing home-day care     
11) Residential home-day care           
12) Residential home-temporarily admission             
13) Residential home-overnight stay  
14) Residential home-meals    
15) Residential home-social or creative activities

At LASA-I only the first four services were asked as the indication for and use of residential care was asked in the medical interview (see LASA189).

 

Questionnaires
LASAB044 / LASAC044 / LASAD044 / LASAE044 / LAS2B044 / LASAF044 / LASAG044 / LASAH044 / LAS3B044 / LASMB044 / LASAI044
(main interview, in Dutch)

Variable information
LASAB044 / LASAC044 / LASAD044 / LASAE044 / LAS2B044 / LASAF044 / LASAG044 / LASAH044 / LAS3B044 / LASMB044 / LASAI044
(pdf)

Use of medical services (hospitalization, contact with specialists)
Use of four types of medical services is asked at all waves. During the main face-to-face interview, respondents were asked if over the last 6 Months they had contact for themselves with a Medical specialist. If affirmative it was posed which kind of medical specialist it was. Furthermore, it was asked if the respondent was hospitalized over the last 6 Months. If admission to hospital was answered affirmative, the reason for admittance was noted. It was also asked whether the respondent had contacted a psychiatrist for him/herself.  Finally, a question was raised whether the respondent was hospitalized in the Psychiatric department over the last 6 Months.

Questionnaires
LASAB045 / LASAC045 / LASAD045 / LASAE045 / LASA2B045 / LASAF045 / LASAG045 / LASAH045 / LAS3B045 / LASMB045 / LASAI045 (main interview, in Dutch)

LASAC603 / LASAD603 / LASAE603 / LASAF603 / LASAG603 / LASAH603 / LASAI603
(telephone interview with PROXY, in Dutch)
LASAD703 / LASAE703 / LASAF703 / LASAG703 / LASAH703 / LASAI703
(telephone interview with RESP, in Dutch)

In wave C the same questionnaire was used for both respondent and proxy, see LASAC603

Variable information
LASAB045 / LASAC045 / LASAD045 / LASAE045 / LAS2B045 / LASAF045 / LASAG045 / LASAH045 / LAS3B045 / LASMB045 / LASAI045
(pdf);
LASAB245 / LASAC245 / LASAD245 / LASAE245 / LAS2B245 / LASAF245 / LASAG245 / LASAH245 / LAS3B245 / LASMB245 / LASAI245 (specification of medical specialist over the last 6 months
(pdf, in preparation)

LASAC603 / LASAD603 / LASAE603 / LASAF603 / LASAG603 / LASAH603 / LASAI603
(pdf);
LASAD703 / LASAE703 / LASAF703 / LASAG703 / LASAH703 / LASAI703
(pdf)

Availability of information per wave 1:

 

B

C

D

E


2B*

F

G

H



3B*
MB* I

Use of health and social services

Ma

Ma

Ma

Ma

Ma

Ma

Ma

Ma

Ma Ma Ma

GP

Tel_resp
Tel_proxy

Tel_resp
Tel_proxy

Tel_resp
Tel_proxy

Tel_resp
Tel_proxy

-
-

Tel_resp
Tel_proxy

Tel_resp
Tel_proxy

Tel_resp
Tel_proxy

-
-
-
-
Tel_resp
Tel_proxy

Medical services

Ma
Tel_resp
Tel_proxy

Ma
Tel_resp
Tel_proxy

Ma
Tel_resp
Tel_proxy

Ma
Tel_resp
Tel_proxy

Ma

-

-

Ma
Tel_resp
Tel_proxy

Ma
Tel_resp
Tel_proxy

Ma
Tel_resp
Tel_proxy

Ma

-

-

Ma

-

-

Ma

Tel_resp

Tel_proxy

1 More information about the LASA data collection waves is available on:         
http://www.lasa-vu.nl/data/lasa/sampleLASAdatacollection.html

* 2B=baseline second cohort;
   3B=baseline third cohort;
   MB=migrants: baseline first cohort

Ma=data collected in main interview;     
Tel_resp=data collected in telephone interview with respondent;           
Tel_proxy=data collected in telephone interview with proxy       

Previous use in LASA           
Many papers are concerned with period/cohort comparisons of the use of care, because this reflects in potential developments in access and allocation of health care over time. Other papers focus on specific groups, and a third line of papers uses a longitudinal design to study changes in health care and service use over time. There are about four lines of studies to distinguish:

  1. Differences by socio-economic status
  2. Differences relating to health and mental functioning
  3. Transitions in use of care, including residential care
  4. Historic developments in use of care

References

  1. Beekman, A.T.F. (2000). Depression and medical illness in later life. Primary Care Companion. Journal of Clinical Psychiatry, 2, Suppl 5, 9-16.
  2. Boumans, J., Deeg, D.J.H. (2011). Veranderingen in de kwaliteit van leven van thuiswonende ouderen: speelt de vorm van zorg een rol? [Changes in the quality of life of older people living at home: does type of care play a role?] Tijdschrift voor Gerontologie en Geriatrie, 42, 170-183.
  3. Broese van Groenou, M.I. (2000). Minder gezond, dus meer zorg? Een onderzoek naar sociaal-economische verschillen in zorggebruik door ouderen.In D.J.H. Deeg, R.J. Bosscher, MI. Broese van Groenou, L.M. Horn, C. Jonker (Ed.), Ouder worden in Nederland. Tien jaar Longitudinal Aging Study Amsterdam (LASA) (pp. 147-154). Amsterdam: Thela Thesis.
  4. Campen, C. van,  Broese van Groenou, M.I., Deeg, D.J.H. & Iedema, J.  (2013). Met zorg oud worden. Den Haag: SCP. (Care trajectories in ten year time).
  5. Campen, C. van, Iedeman, J., Broese van Groenou, M.I. & Deeg, D.J.H. (2017). Langer zelfstandig. Ouder worden met hulpbronnen, ondersteuning en zorg. Den Haag: SCP.
  6. Comijs, H.C., Dik, M.G., Aartsen, M.J., Deeg, D.J.H., Jonker, C. (2005). The impact of change in cognitive functioning and cognitive decline on disability, well-being, and the use of healthcare services in older persons: results of the Longitudinal Aging Study Amsterdam. Dementia and Geriatric Cognitive Disorders, 19, 316-323.
  7. Deeg, D.J.H., Broese van Groenou, M.I. (2007). Zorggebruik door ouderen na opname in het ziekenhuis: Ontwikkelingen in 1992-2002. Tijdschrift voor Gezondheidswetenschappen, 85, 3, 174-182.
  8. Portrait, F.R.M., Deeg, D.J.H., Lindeboom, J. (2000). Ziekteprofielen, levensverwachtingen en zorggebruik.In D.J.H. Deeg, R.J. Bosscher, M.I. Broese van Groenou, L.M. Horn, C. Jonker (Eds.), Ouder worden in Nederland. Tien jaar Longitudinal Aging Study Amsterdam (LASA)(pp. 117-124). Amsterdam: Thela Thesis.
  9. Pot, A.M., Portrait, F.R.M., Visser, G., Puts, M.T.E., Broese van Groenou, M.I., Deeg, D.J.H. (2009). Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based study. BMC Health Services Research, 9, 139.
  10. Van der Scheer, E., Boersma, F., Deeg, D.J.H. (2003). Gezondheidstoestand en zorggebruik van bewoners van service-ouderenwoningen. Een vergelijking met zelfstandig wonenden. Tijdschrift voor Gerontologie en Geriatrie, 34, 162-167.

Reports for the Ministry of Health, Welfare and Sport

  1. Comijs, H.C. (2013). Somatische en psychische problematiek bij ouderen; samenhang en zorggebruik (LASA-rapport 2012).
  2. Plaisier, I., Broese van Groenou, M.I. & Deeg, D.J.H. (2012). Kwetsbare ouderen: zorg of geen zorg? LASA-report 2011 voor het ministerie van VWS. Amsterdam: LASA, VU/VUmc.
  3. Plaisier, I., van Tilburg, T.G., Deeg, D.J.H. (2011). Mogelijkheden voor preventie van AWBZ-gebruik: netwerken van zelfstandig wonende ouderen [Opportunities for prevention of publicly paid care: social networks of independently living older adults]. LASA-report 2010.
  4. Thomese, F. & Tolkacheva, N. (2013). Verhuizing naar (semi)residentiële woonvormen. [Moving into (semi)residential care]. LASA-report 2013.
  5. Van Vliet, M.G., Broese van Groenou, M.I. en Deeg, D.J.H. (2010). Extramurale zorgzwaartepakketten. Rapport in opdracht van het ministerie van VWS. Amsterdam: LASA.
  6. Broese van Groenou, M.I and D.J.H. Deeg (2007) Gebruik van thuiszorg en welzijnsvoorzieningen door 55-plussers tussen 1992 en 2006. Een onderzoek naar individuele en historische ontwikkelingen. Onderzoek uitgevoerd in opdracht van ministerie VWS.